Job description
Physical health is never just about our body, it is about our mind, feelings and ambitions. When something holds it back, it’s our whole life on hold and we’re here to change that. Smith+Nephew aims to use technology to take the limits off living and help other medical professionals do the same. This will enable everyone from farmers, athletes, grandparents and their grandkids to stare down fear and see that anything’s possible. Now they will have the ability to go on stronger while inspired by a simple promise. The two words that bring together all we do: LIFE UNLIMITED. Our Cultural Pillars are CARE, a culture of empathy and understanding for each other, our customers and patients, COLLABORATION, a culture of teamwork, based on mutual trust and respect, and COURAGE, a culture of continuous learning, innovation and accountability.
This role serves as a reimbursement subject matter expert within the Healthcare Strategy & Reimbursement (HCSR) group, while developing and managing reimbursement (coding, coverage and payment) strategy for current, new and/or expanded uses of S+N Orthopedics products and technologies. This role will provide strategic insight through landscape assessments for new product development and due diligence activities, integrate reimbursement strategy with evolving alternative payment models (Accountable Care Organizations, bundled payment models, etc) and devise value-based healthcare incentives to encourage providers and payers to adopt technologies that improve clinical outcomes. This includes working with internal teams on strategically engaging ECRI, Hayes, and other Health Technology Assessment and utilization guidelines groups on the evidence associated with S+N ortho technologies.
In addition, this role will work in close collaboration with the business in developing reimbursement analytics, assessing payer coverage policies, and creating customer-facing reimbursement and value dossier tools, in conjunction with Market Access and Health Economics team. Experience in leveraging the use of claims-based evidence and other uses of real-world evidence are helpful but not required. While this role is designed to exclusively support Orthopedics, some time may be dedicated to Sports Medicine and ENT reimbursement support on an as needed basis.
The Director of Reimbursement, Orthopedics, will report to the business on reimbursement challenges and opportunities, and support the VP of HCSR in advocating for quality and payment policy changes with CMS and AdvaMed. This role will also manage customer reimbursement efforts between Smith+Nephew sales force, internal marketing staff, legal and compliance as it relates to franchise & reimbursement initiatives, while providing OUS reimbursement expertise and assessments as needed on periodic basis.
Essential Functions:
- Develop reimbursement, coding and coverage strategies to advance Orthopedics, including efforts to highlight clinical and economic value of products; work with Health Economics team and Data Analytics teams in support of developing Value Dossiers, Reimbursement Tool Kits and other related materials. 25%
- Research private and public payer coverage trends while identifying opportunities to secure appropriate reimbursement and/or innovative partnerships with payers for Orthopedics technologies, possibly with the support of external consultants. Develop recommendations for Franchise strategic direction based on both provider and payer reimbursement environment. 25%
- Develop innovative reimbursement support programs and tools for internal and external customers in close collaboration with marketing, sales, and Market Access. Responsibilities also include development of sales force reimbursement training materials. 25%
- Plan, develop, and implement revisions and enhancements to reimbursement programs, and create standard operating policies and procedures. Create and/or manage creation of Ortho coding guides in collaboration with the Director of Reimbursement for Sports Medicine while updating materials as needed on the reimbursement web site on timely basis. 25%
Travel: 10% of the time
Education: Master degree (preferred) or Bachelor’s degree in relevant field (Public Policy, Health Economics, Medical Training)
Experience:
- Minimum of 10 years of reimbursement experience, with a strong ability to communicate the benefits of our medical devices to patients, providers and payers. This may include several years of experience working at a managed care plan, and/or 7+ years in the medical device industry working across multiple business functions.
Competencies:
- Experience (1) working across multiple business functions to advance business objectives, (2) developing health care policies and reimbursement strategies that align with business objectives and (3) building and working with stakeholder coalitions to advanced business objectives
Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.
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